Magazine article Clinical Psychiatry News

Smartphone App Aimed at Disrupting Early Psychosis

Magazine article Clinical Psychiatry News

Smartphone App Aimed at Disrupting Early Psychosis

Article excerpt


BETHESDA, MD. -- What would the world look like for people with first-episode psychosis if they could be identified before they ended up in care? And what if once identified, they could begin receiving treatment immediately?

Those questions are not just hypothetical to Danielle Schlosser, PhD, assistant professor in the department of psychiatry at the University of California, San Francisco.

Dr. Schlosser discussed the implications of the ongoing, randomized, controlled Personalized Real-Time Intervention for Motivation Enhancement (PRIME) trial at the annual National Institute of Mental Health Conference on Mental Health Services Research.

Using online screening based on proven tools, followed by enrollment in a secured, closed community created through the use of a smartphone app, Dr. Schlosser and her colleagues are delivering remote care to people with first-episode psychosis, rather than making them come to the clinic. "It's controversial, but you're not doing anything meaningful if you don't stir things up," Dr. Schlosser, director of the National Institute of Health-funded Digital Research and Interventions for Volitional Enhancement lab, said in an interview. "Why do we have to have a one-size-fits-all model?"

Statistics from NIMH show that duration of psychosis before treatment is 1-3 years. People in the early stages of psychosis, typically in their late teens or early 20s, often do not find their way to care until after admittance through an emergency department or a brush with the law, Dr. Schlosser said.

Role of stigma in outcomes

Once diagnosed, clinically meaningful improvements in outcomes in this cohort often are impeded by cognitive and motivational impairment, including fear of stigma, or logistical challenges such as finding reliable transportation to a treatment site.

According to the World Health Organization, half of all people with schizophrenia globally are not receiving treatment.

"We can do better," said Dr. Schlosser, who also serves as director of the digital health core in the university's psychiatry department.

In the PRIME design trials, Dr. Schlosser and her colleagues are evaluating how "user-centered design" might improve treatment delivery. In stage 1 of the study, two design phases, each with a separate group of 10 participants with recent-onset schizophrenia, helped a global design firm called IDEO arrive at a product that Dr. Schlosser and her colleagues described in a study published online as "casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis."

The app included short motivational texts from trained therapists, a feature for individualized goal setting in prognostically important psychosocial domains, opportunities for social networking via direct peer-to-peer messaging, and a community "moments feed" aimed at capturing and reinforcing rewarding experiences and achieving goals.

"Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness)," Dr. Schlosser and her colleagues wrote (JMIR Res Protoc. 2016;5[2]:e77).

High satisfaction

After 12 weeks of using the app, Dr. Schlosser and her coinvestigators found that trial participants, all of whom had been asked to use it at least once a week, had used it an average of once every other day and had actively engaged with its various features with every log-in. …

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